Raised PSA

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Testing in asymptomatic patients

There is no screening programme but it is reasonable to carry out PSA in patients who request testing in the following groups:

  • Age 50 and over
  • Age 45 and over with risk factor
    • First degree relative with prostate cancer (brother/father)
    • Black or mixed black ethnicity
    • Carry a BRCA gene variant

Leaflets to support this are available on Prostate Cancer Risk Management site

PSA testing in elderly

PSA testing in men age 80 and over should be avoided unless there are symptoms suggestive of metastatic prostate cancer.

Assessment

Patient presents with urinary symptoms or has requested PSA testing.

Consider:

  • Lower urinary tract symptoms
  • Infective symptoms - exclude UTI before testing PSA
  • Family history of prostate/ovarian/breast cancer
  • Bone pain

Before having a PSA test men should not have:

  • an active UTI (PSA may remain raised for many weeks) - large effect
  • ejaculated in the previous 48 hours - small effect < 1 mcg/l
  • exercised vigorously in the previous 48 hours - moderate effect 50-90% rise
  • had a prostate biopsy in the previous 6 weeks - large effect
  • had a DRE in the previous 24 hours - very small effect <0.25mcg/l

If a raised PSA result is received in the context of a suspected or proven UTI repeat after 6 weeks

Who to refer

Refer fast track prostate pathway

  • PSA > 10 

Mandatory tests:

  • Rectal examination
  • U&E
  • MRI Checklist:
    • Presence of shunts/pumps/heart valves
    • Orbital foreign body/shrapnel
    • Cranial surgery/aneurysm clips
    • Claustrophobia
    • Cochlear implant
    • Pacemaker

Exclusion criteria:

  • Age ≥ 80
  • Unfit for active treatment
  • Patients unable to attend appointments Monday AM
  • Patients who decline/are not able to have DRE

These patients can be referred via the existing urology referral pathway

Refer via SCI-Gateway Urology...Fast track prostate referral

Symptoms or signs of Cauda Equina Syndrome need emergency discussion with on-call team

Refer urgent suspected cancer

For patients in whom fast track referral not indicated.

Refer immediately:

  • Under 70: PSA ≥ 3 ng/ml
  • 70-79: PSA ≥ 5 ng/ml
  • 80 and above: PSA ≥ 20 ng/ml (or ≥ 7.5ng/ml with features suggestive of metastatic disease)

Refer via SCI-Gateway...Urology...Urological

Symptoms or signs of Cauda Equina Syndrome need emergency discussion with on-call team

Age-specific PSA ranges

  • Under 70 years < 3.0
  • Age 70-79 < 5.0

In older men consider realistic medicine principles. Routine or no referral may be appropriate.

  • Age 80 and over ≥ 20.0

Who not to refer

  • Raised PSA in context of infection (repeat in 4 weeks and refer if still raised)
  • If downward trend could be repeated again after 4 weeks
  • Frail elderly in whom a diagnosis of prostate cancer would not affect their management

Editorial Information

Last reviewed: 11/01/2026

Next review date: 11/02/2028

Author(s): Ian Russell.

Version: 1.1

Reviewer name(s): Fiona O'Brien, Fergus Donachie.